Pages

Blogroll

Meta

ATR Rupture March 2nd: almost 9 weeks
NON-Op….no insurance. if you have insurance GET THE SURGERY!! I NOW have insurance through my work!
timeline: if anyone is interested what I did going the Non-Op route.

Weeks 1&2 in a cast angled down / crutches (NWB)
Weeks 3&4 in a boot 30 degrees down/ crutches (did my own exercises and PWB)
Week 5 in a boot @ 22 degrees down (PWB)
Week 6&7 in a boot @ 15 degrees down (PWB some FWB hobbling around)
Week 8 in a boot @ 7.5 degrees down (PWB / a lot of FWB) on and off crutches
WEEK 9 @ 0= neutral. threw the crutches in closet
Had my doc appt today 2 days shy of ATR. He said it looked good and my range of motion was good and no swelling.
He wants me to stay in the boot walking around for 2 more weeks or more and start weaning off of the boot. that will take me up to week 11. He is NOT a fan of the non-op route but I/we had no choice.
I have been rubbing DMSO on my injury and have been using it since 2003 when playing rugby in Brazil a coach had me try it on my knee. And I swear it is the best stuff!
I also have been standing FWB just watching TV etc for a week or so to get the foot used to weight….I weigh 240#! I have also walked to the bathroom and across the bedroom a few time the past 3 days without the boot in bare feet walking slow. I have not felt any of these foot pains i read about on this blog.
good luck everyone!

I am a non-op ATR dude at week 4 1/2.
Cast 2 weeks now on crutches in my Don joy mc walker boot.
I wanted to know what degree settings some used. I was at 30 degrees plantar for 2 weeks and now at 22.5 for 2 weeks. Doc ( jerk hates atr non-op) said every 2 weeks go down another pin see ya in a month. So that would take me to neutral at 10 weeks?
I want or wanted to be at neutral off crutches in 8-9 weeks. Do you think it would be safe to skip a week and jump to 15degrees now? Then 7.5 in 2 weeks then neutral at week 9?
Any advice or tips?

I am 4 weeks after rupture going the NON- Op route. I was put in a cast for 2 weeks and then a donjoy boot angled down since then. Was at 30 degrees down and just got moved up to 22.5 degrees for 2 weeks. Since I was moved up I have noticed a slight burning sensation up entire Achilles.
Burning is the only way I can describe it. Is this common?

Recent Comments

Djh, I also wonder why you wish you’d gotten cut instead, since your progress seems reasonable, and only a bit slower than my fave (op or non-op) protocol, from the UWO study.

I also wonder what you meant by your “Had my doc appt today 2 days shy of ATR.” 2 days shy of 10 weeks?? I’m confused.

@Janus: I get miffed when people refer to the non-op cure as “conservative” in 2012. I know that skipping surgery is often called conservative because it avoids a bunch of surgical risks. But in the ATR context, it USED to also mean “We’ll be safe and avoid re-ruptures by going way slow.” And going non-op used to mean going way slow, but ~4 recent studies (2007-2010) have shown that going non-op and FAST produces better results than going way slow! (Going way slow post-op also doesn’t help, but the outcomes don’t seem to be as different.) So the best non-op ATR cures seem almost scary aggressive — way too fast for many Docs who prefer repetition to evidence — which doesn’t seem to fit the word conservative. [End of rant]

Well, I had no insurance — and screwed up the process so that it was 6 weeks before I had a proper diagnosis. So at that point, with chronic tendonitis, surgery was best option — despite setting me back about 15K in what were alleged retirement savings. At least it didn’t drive me into bankruptcy.

That said, I’m tempted to say that had I gotten this right in first place, I might have been more than willing to try the conservative / non-surgical option.

So I share RyanB’s question. That said, I also agree w/ RyanB that you seem right on schedule — and look like you’re well on your way to recovery.

So congrats! Feel good about that. & you may yet be happy that you chose the conservative option. I’m happy w/ my surgery, but not with what I paid for it! Or how various parties jerked me around in the process. Staying away from hospitals is generally a good thing.

Glad however that you’re insured again; and even more so, that you’re on track to recovery.

You should be able to walk through an airport by week 11, in or out of the boot, most people as far as I have read on here and from my own experience will be comfortably FWB by that point if there have been no other complications.

From where you are now its just a case of building up to FWB and then work on walking, if it gets sore and swells stop and do RICE, as for the wedges once you are near flat you should be able to “walk” you can try lowering faster it will feel very tight, again let pain guide you.

Are you off crutches FWB at 5 weeks. I just hit my 5 week mark today.
I hobble here and there without crutches. Not anywhere far. Couch to chair. Chair to bathroom etc.
What degree is your boot set at? I am in the Don Joy max traxx boot.

Brian:
I had a complete tear and went non surgical too. Thompson test confirmed it. MRI was not necessary and at about $2.000 a pop, the insurance would have frowned on it. If I went the surgical option, an MRI would have been necessary to confirm the location of the tear. Got my boot 2 weeks ago and the doctor said there was still a small gap. I could feel it and it seemed less than a .5 cm. Went for another check up yesterday and the gap had closed.

dhj:
I know what you mean by keeping your fingers crossed and waiting. I asked my doctor if there is ever a case with non surgical if the tendons don’t come together and he said flat out NO. I then asked him what is the general cause of re-rupture and he said just the quality of the repair the body does. Yes the latest studies do indicate little difference in the results of surgical vs. non surgical. Time to recovery does seem a bit faster for surgical but I was FWB at 5 weeks in my boot. Doesn’t seem like you can go much faster than that. And with non surgical, the very real risks of serious infection or the skin not healing properly are just not there.

Hi All
If it helps anyone my recent recovery so far is:Full Left ATR, Non-op.
Weeks 1-7 Boot fitted with 4 wedges.
Week 8 Started Partial weight bearing.
Week 9 Full weight bearing (still wearing boot).
Week 10 Final wedge removed. Started physio. Walking around with boot fitted. One crutch helps.
Continued wearing boot day and night!
Very weak on ball of foot. Tyring hard with physio but this sems to be a slow process. .
Week 11 Walking with and without boot fitted. No crutches. Without boot walking is slow.
Week 12 - Discarded boot at last and walking much better.
Still limping due to weakness on ball of foot.
Week 13 - Getting stronger, limp almost gone.

sure, I was non-op too, and was 2wks cast, 2 weeks fully wedged in boot PWB, 4 weeks 50% planarflex FWB in boot then 3 weeks neutral in boot / barefoot when at home so took much less “steps” than you state in your OP, think most would be neutral by around 8-9 weeks FWB if it feels ok go for it.

keep the crutches for longer excursions but I found I could do without from pretty much the point I went neutral (used them on and off before that) just try and make sure you walk as “normally” as possible not turning your foot out too much

Oh I have read the UWO protocol and many other. I just think getting surgery is a better route and wish I would have had that option! I just don’t see why one would want a longer wait and have to heal longer and done ever
Know if it is healing correctly. If it is sewn together then I KNOW it is together and up to me to let it heal and rehab.
Just my opinion!

djh232, feel your pain, but and ryanb etc know more than me, all of the more recent studies (such as the UWO one http://achillesblog.com/files/2008/03/jbjsi01401v1.pdf) have shown there to be next to no difference been operative and non-operative rehab treatment for achillies rupture on a modern early mobilization protocol, so you’ll be fine, just don’t try and go tooo fast…

My insurance for new job does not kick in until June 1st. If I would have had insurance I would have had surgery. I would know the Achilles would be seen together and fixed. This non oP crap and just keeping fingers crossed and waiting. I have to be at work by may 18 so if I can’t walk and fly overseas for work I am screwed and have no job with a house, wife as 2 kids.
If my a miracle this heals in 11 weeks and I get to work and it pops again I will have surgery ASAP! Letting my insurance expire for 3 months was a major brainfart.
Get the surgery people! Don’t cross your fingers and hope get the Achilles seen together! I have had my knee surgeries and always fixed them and i knew they were fixed!

I had a complete rupture - you could feel the gap in the tendon down low near my heel- the doctor showed me & I felt it. (Plus I had a positive Thompson test.) He said an MRI wasn’t necessary & that the treatment would be the same in any case (casting in plantar flexion so that the ends of the tendon are next to each other & can heal). We didn’t really talk about the width of the gap. He told me that years ago surgery was standard, but that he feels that non-op works just as well as surgery with less risks. And on Tuesday the tendon had rejoined - it was visible & palpable again, which was a great relief. Now I’m just paranoid about re-rupturing during the healing process.

Hi Cindy,
Glad to hear that things are working out ok so far by going the non-OP route. Just curious (also a question for others who went non-OP), did you have a MRI before deciding to go the non-OP? If so, was it a complete rupture and how much separation was there between the two sides of the tendon? I “only” had a 0.5cm separation, so was tempted to go the non-OP route…
Thanks,
Brian

I am also non-op at week 4.5 - I was in a cast (NWB) for 4 weeks, then on Tuesday 4/3 my doctor put me in a fixed boot at neutral, and now I’m PWB but still with 2 crutches [sigh]. It was painful to put my foot in the boot at neutral, and the tendon area was sore all that day, better on Wed., and fine yesterday. So based on my experience it seems like you could move it up a notch and see how it feels.

How do you like your boot? Mine is an Ossur air boot and it still feels very heavy to me.

I am non-op but partial rupture so I don’t know how much help I can be. I know there are concerns about the tendon healing long…Being an ultrarunner my doc was actually worried about me healing short so he had me in a boot at neutral right away as he wanted me to have as normal a running gait as possible when I return to running. I was a little concerned about this when I first visited some of the blogs here…But so far so good my leg is pretty strong, not sure if it’s because my rupture was partial and so maybe there is less of a concern for healing long. I think there is a bit of a consensus around these blogs that you should listen to your doctor tho there is probably room to move forward a bit quicker than some of the docs suggest. Every one is different and I would at least try if I was in your position but back off if it’s too weird or painful.

RT, did you have more pain with non-op than post-op? Neither of my ATRs or recoveries was esp painful, but the surgery sure hurt more than anything non-op. Post-op patients usu get fancy pain killers, and non-ops usu don’t need any.

Do not take Advil! …Or any anti-inflammatories for that matter; I learned from my surgeon and PT that these may reduce pain and swelling but while doing so, they pull healing interstitial fluids away from the injury, weakening the healing process and encouraging the growth of scar tissue, which is hell to get rid of (you will experience this in PT massage if you haven’t yet). Pain is common, and with non-op (in my experience) almost constant. Stick in there!

I’m at almost 3 weeks since surgery, the burning sensation happened with me too, however I think it was due to swelling from my stitches. I assume with your case it’s the swelling from the tendon. Hopefully it will let up soon, mine isn’t as bad as it was before, advil helps a lot!